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The Medical Advancement of Personal
Needs

By Vincent M. Riccardi, MD

(Page 1 of 2)

Among the many types of
responsibilities for caregivers, there are three I wish
to address here: those that are clearly medical, those
that clearly address personal needs and those in the
gray area in between. First, let’s consider the three
categories. Physicians, nurses and other clinicians,
most often assume medical responsibilities but, under
special circumstances, the patient or caregiver may take
over, at least temporarily. The responsibility for
personal needs, such as bathing and feeding, is almost
entirely assumed by the patient or the caregiver, except
when the patient occupies a bed in hospital or nursing
home. The gray area of responsibility is the main focus
of this piece. Examples include the administration of
insulin by injection, taking the pulse and blood
pressure, and so on.

My prediction is that with increasing speed we will see
a shift in the number of responsibilities from the
medical arena and health care professionals through the
gray zone to caregivers to attend simply as personal
needs. Healthplans will be covering fewer and fewer
benefits. That is, medical responsibility – as defined
by those paying for them as benefits – will be more and
more circumscribed.

When I graduated medical school in June 1966, I
considered it one of my primary responsibilities to
characterize almost any need a patient had as being
appropriately covered as a benefit under the patient’s
healthplan. Physicians were essentially able to
establish medical necessity by declaration. Another way
to look at it is that I participated in an American
cultural and social movement to medicate essentially all
the needs of patients. If the patient had a need, we
construed it as representing a medical necessity.

I cannot pretend to know all of the reasons for such an
approach on a national scale. But, I do know it was
there and that I was an enthusiastic participant, a part
of the apparent triumph of the downtrodden over
corporate America. However, medical advancement had
other origins as well, including an increasing emphasis
on public health and preventive medicine. What you ate
became a medical matter. Cigarette smoking became a
medical matter. Jogging and other exercise became a
medical matter. Automobile seatbelts became a medical
matter. Within a short period of time – perhaps a decade
– every activity had a medical basis and history in
America. This was good for many people. The notion was
that anything that had to do with health, well-being and
normal functioning was “medical” and therefore a covered
healthplan benefit.